Individual
OLIVER RUSSELL
Active
Individual
OLIVER RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW-C
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0904005217
VA
1041C0700X
Clinical Social Worker
Primary
10749
MD
1041C0700X
Clinical Social Worker
LC3000796
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0904005217
—
VA
05
—
LC30007976
—
DC
05
—
LCSW-C10749
—
MD
Enumeration date
05/22/2007
Last updated
01/08/2014
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